From the Guidelines
Venous hypertension can manifest in several distinct forms, including primary, secondary, portal, pulmonary, chronic venous insufficiency, and central venous hypertension, each with different underlying causes and potential complications. According to the study by the American Heart Association 1, venous hypertension can occur due to outflow obstruction or venous valvular reflux, leading to ambulatory venous hypertension. The study explains that when an individual is upright but motionless, venous pressure is highest, increasing to up to 80 to 90 mm Hg, and that any damage to the venous valves impedes venous return to the heart, leading to venous hypertension and consequent leg pain and swelling.
Some key types of venous hypertension include:
- Primary venous hypertension, which occurs in the absence of identifiable causes and is often related to inherent venous wall or valve weaknesses
- Secondary venous hypertension, which develops due to underlying conditions such as deep vein thrombosis, which obstructs blood flow, or external compression from tumors or fibrosis
- Portal hypertension, which specifically affects the portal venous system, typically resulting from liver cirrhosis that impedes blood flow through the liver
- Pulmonary venous hypertension, which involves increased pressure in the pulmonary veins, commonly due to left heart failure causing backward pressure transmission
- Chronic venous insufficiency, which represents a long-term form of venous hypertension in the lower extremities, characterized by valve dysfunction leading to blood pooling and symptoms like edema and skin changes
- Central venous hypertension, which affects the superior vena cava system, often due to obstruction or heart failure
As noted in the study 1, the literature on whether postthrombotic syndrome (PTS) development is predominantly the consequence of outflow obstruction, venous valvular reflux, or both is conflicting, which may reflect, in part, the limited ability to quantify venous obstruction and reflux. However, management approaches vary based on the specific type and underlying cause of venous hypertension, but may include lifestyle modifications, compression therapy, medications like diuretics or anticoagulants, and in some cases, surgical interventions to address the root cause of the increased venous pressure.
From the Research
Types of Venous Hypertension
- Superficial (simple) venous hypertension: occurs due to the hydrostatic force of gravity, resulting in insufficiency of the superficial venous valves 2
- Deep (complicated) venous hypertension: results from dysfunction of the musculovenous pump of the lower extremities, leading to primary valvular insufficiency of the deep veins 2
- Venous hypertension due to varicose veins: classically results from incompetence of the major communications between the superficial and deep veins of the lower extremity 3
- Venous hypertension due to isolated perforating and nonsaphenous vein incompetence: occurs in a significant number of patients with varicose veins 3
Characteristics of Venous Hypertension
- Superficial venous hypertension:
- Deep venous hypertension:
- Underlies the formation of deep hypertension 2
- Primary valvular insufficiency of the deep veins induces the formation of hemodynamically significant refluxes in the deep, superficial, and perforating veins 2
- The work of the musculovenous pump is impaired, leading to phlebostasis and capillary stasis 2